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2020 | October-December | Volume 54 | Issue 4

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Sidak Dhillon, Aditya Aggarwal

Ethics in Sports Medicine

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:2] [Pages No:173 - 174]

   DOI: 10.5005/jp-journals-10028-1422  |  Open Access |  How to cite  | 



Milkha Singh, Jeev Milkha Singh

In Conversation: Evolution of Sports Medicine and Support for the Elite Indian Athlete—From 1960 to 2020

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:3] [Pages No:175 - 177]

   DOI: 10.5005/jp-journals-10028-1415  |  Open Access |  How to cite  | 


Milkha Singh is perhaps the most iconic track athlete from India, and his son Jeev Milkha Singh has been Asia's top Golfer for over 20 years. In conversation with the Editor MS Dhillon, the elite duo describe the level of medical support and the evolution of sports sciences relevant to elite athletes in the 1960s and compare it with the medical facilities and support that is available for athletes in India in the 21st century. Both discuss the issues that they feel are pertinent to develop sports sciences in India to a level equivalent to that in the world.



Philippa J Inge, Nirmala KP Perera, John W Orchard, Leigh Golding

Exercise as Medicine—Evidence for Prescribing Exercise for the National Health Priority Areas: An Umbrella Review

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:28] [Pages No:178 - 205]

   DOI: 10.5005/jp-journals-10028-1381  |  Open Access |  How to cite  | 


Objective: To describe the relationship between exercise and Australia's nine national health priority areas (NHPAs), which are arthritis and musculoskeletal conditions, asthma, cancer control, cardiovascular health, dementia, diabetes mellitus, injury prevention and control, mental health conditions, and obesity. Materials and methods: CINAHL, Cochrane Database of Systematic Reviews, PubMed, and SPORTDiscus were searched from 2007 to 2017, inclusive. Included were systematic reviews and meta-analyses reporting the effect of exercise on development, management, and treatment of Australia's NHPAs. Results: A total of 74 studies were fulfilling the inclusion criteria. Moderate exercise effectively treats and manages symptoms of osteoarthritis. Exercise improves maximal oxygen uptake in patients with asthma, prevents breast cancer, and reduces hospital admissions for patients with heart failure. Exercise significantly reduces the risk of type II diabetes mellitus and assists weight control. Exercise reduces the risk of vascular dementia, delays cognitive decline, and is effective in falls prevention. Exercise reduces symptoms of anxiety and is an effective treatment for people with depression. Conclusion: Exercise had a positive/beneficial effect in all nine NHPAs. However, it doesn\'t have universal beneficial effect for every subdisease. From a clinical perspective, prescription of exercise to assist in the management and/or prevention of all of the nine NHPAs should be encouraged. Implications for public health: Exercise has a critical role in the national public health strategy for the prevention and treatment of diseases related to inactivity.



Arumugam Sivaraman, Janani Gopalakrishnan, Keddin Alwar Thiagarajan, Suresh Perumal, Prakash Ayyadurai, Utkarsh Singh

A Review of Football Injuries and the Role of 3D Biomechanical Analysis in Injury Prevention

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:7] [Pages No:206 - 212]

   DOI: 10.5005/jp-journals-10028-1420  |  Open Access |  How to cite  | 


Background: Football is the world's most popular game and is rapidly growing in India. Lower limb injuries are a major concern. Applied research in Indian football scenario is required to prevent injuries and enhance performance of the players to take India higher up in FIFA world ranking. Aim: This review aims to concise common lower limb injuries in football and understand the biomechanics of the football kick particularly from the injury risk point of view as well as performance. Review results: Approximately 60–80% of severe injuries to football players occur in the lower extremities, most commonly at the thigh muscles (30%), knee (29%), foot and ankle (11–23%), and groin (8–18%). Biomechanics deals with analysis of human body movements. A combination of spatial dimension analysis (2D or 3D), surface electromyography, and force plate analysis can identify the cause of injury and aid in its prevention while providing information on performance enhancement techniques in addition. Conclusion: Football injuries are widely prevalent with lower limb being the most affected. The game of football is growing in India and injuries are becoming increasingly common affecting the player's career and team's performance. The biomechanics analysis of instep kick provides vital inputs into the injury risk and performance enhancement. Clinical significance: The biomechanical analysis of the football instep kicking action using 3D motion capture, force plates, electromyography (EMG), and applying the data to modify techniques will help in injury prevention and performance enhancement.



Pratik M Rathod, Rajesh K Rajnish

Do Psychological Factors Affect Return to Sport after Anterior Cruciate Ligament Injury? A Narrative Review

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:5] [Pages No:213 - 217]

   DOI: 10.5005/jp-journals-10028-1418  |  Open Access |  How to cite  | 


Background: Psychological factors have a major role that affect the incidence, prevention, rehabilitation and return to sport (RTS) after injuries. There has been an increase in research and more attention towards evaluation of the impact that these factors play in deciding the outcomes after a sports injury. Therefore, the aim of this narrative review was to summarize the evidence for association between psychological factors and returning to sport following anterior cruciate ligament (ACL) injury. Materials and methods: Electronic databases were searched for publications on effect of psychological factors on return to sport after ACL reconstruction. After reviewing the articles found in the database, 20 articles of interest were identified. An additional Google Scholar search was also done to look for any missed articles; and relevant articles were taken from other journals that were added to the narration. The selected articles were read thoroughly to arrive at this review. Observation and analysis: This narrative review has brought to light some interesting facts. The majority of the research about personality and injury has been inconsistent. It means that until now the characteristics of specific personality associated with the onset of sports injuries have not been identified and measured. Stress levels are the strongest predictor of sport injuries. Fear of reinjury/anxiety and pain catastrophizing are significantly correlated with athletes’ confidence in their ability to return to their sport. Higher motivation, self-efficacy and psychological “readiness” are positively associated with return to sport. Resources helping the athletes to cope have suggested to decrease the strength of the stress response and also decrease the amount of perceivable stress by the athletes. More specifically, coping is found to have a buffering effect, and thus decreases the probability of getting injured. Female and male athletes differ significantly when compared with the amount of stress perception, and coping after an injury, and thus gender may be an important factor to be considered in ACL injury and rehabilitation. Conclusion: Positive psychological factors like self-confidence, self-motivation, psychological-readiness, self-efficacy, optimism and social support appear to promote a greater probability of return to sports after ACL injury. Fear of reinjury is most significantly associated with RTS and physical activity levels.



Srinivas BS Kambhampati, Raju Vaishya, Shanmugasundaram Saseendar, Abhishek Vaish

What's New in the Management of Articular Cartilage Injuries in Athletes

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:9] [Pages No:218 - 226]

   DOI: 10.5005/jp-journals-10028-1362  |  Open Access |  How to cite  | 


Aim: To review the literature on management of articular cartilage injuries in elite athletes with a focus on new developments. Background: Articular cartilage injury is a common problem that can lead to significant pain and loss of function. This tissue has a poor healing capacity due to its avascular and aneural status. No treatment option has been completely successful in stimulating articular cartilage repair and regeneration. Such an injury in a professional athlete could turn out to be a performance- or a career-ending event. There is a dearth of evidence on the treatment of articular cartilage injuries in athletes. Hence, we reviewed available evidence on the management of articular cartilage injuries in professional athletes. Materials and methods: A key word search was done on PubMed, Scopus, EMBASE, and Ovid Medline. After filtering, 89 articles were reviewed to extract available evidence on the subject. Results: Overall there are few good-quality reports on the outcomes of cartilage repair and reconstruction techniques, specifically in professional athletes. Most reports are case series or reports. Most commonly involved areas include the femoral condyles, femoral heads, talus, humerus condyles, and the humeral head. Various treatment options have been tried and include chondroplasty, microfracture and its various modifications, bilayered autograft and allograft transplantation, and cell-based regenerative techniques (platelet-rich plasma, autologous cultured chondrocytes, and mesenchymal cells). Conclusion: While most treatment methods have produced good results in the short- and mid-term, little good-quality evidence is available on their long-term results. The newer techniques such as tissue engineering methods, 3D bioprinting, and gene therapy appear to be promising. But these are still in preclinical state and are likely to pave way to better treatment options in the future. Clinical significance: Elite athletes are a challenging group of patients who require exacting techniques, more demanding than the general population, to restore their function and return to play at same level. Current available techniques restore their function to a large extent, but outcomes may be improved. Cartilage restoration techniques are evolving, and newer techniques are developing to improve outcomes.



J Kumaravel, Dhruv Mahendru, Vidya M Mahalmani, Phulen Sarma, Ajay Prakash, Bikash Medhi

Athlete Biological Passport: Practical Application in Sports

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:4] [Pages No:227 - 230]

   DOI: 10.5005/jp-journals-10028-1380  |  Open Access |  How to cite  | 


The role of athlete biological passport (ABP) is the longitudinal tracking of the doping biomarkers. There are three modules of this program: hematological, steroidal, and endocrinological. As of now, only the first two modules have been executed. The ABP program has become stronger since the introduction of the hematological module and is a vital instrument to combat doping malpractices. Since the ABP program focuses on the longitudinal tracking of various parameters that are affected by the use of performance-enhancing substances, it may be called an indirect tool for the detection of doping. The Athlete Passport Management Unit (APMU) linked with the laboratories performing the antidoping testing takes care of the administrative side of this program for ensuring an unbiased analysis of the outcomes after the evaluation of the passport. The results of the ABP profile of an athlete might be influenced due to some factors leading to misinterpretation of the data, which is a challenge for the authorities and needs to be looked upon. It is an important tool in the fight against doping. Recent developments in metabolomics show the ABP's tremendous potential. ABP's further progress with close analysis of biological parameters is now the most effective approach to stop athletes using undetectable banned substances.



Abhishek K Tiwari, Ashutosh S Pandey, Subham Badhyal

Design and Development of a Device for Performance Analysis and Injury Prevention in Boxing

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:5] [Pages No:231 - 235]

   DOI: 10.5005/jp-journals-10028-1401  |  Open Access |  How to cite  | 


Aim: The present work focuses on the design and development of a device for performance analysis and injury prevention in boxing. Materials and methods: A boxing glove embedded with tri-axial accelerometers and 3-axis gyroscope connected through Aurdino board is developed. In addition, a punch force analysis target system embedded with pressure sensors has also been developed. Results: Boxing performance parameters such as reaction time, punch force, fist's angular rotation, acceleration, and velocity in 3D space are analyzed for nine college athletes. Boxing parameters such as acceleration, fist rotation, and the force generated involved in hook punch vs straight punch is analyzed. Moreover, the effect of shorter and longer reach length on boxing performance has also been observed. Greater punching power is observed during hook punch. Increase in fist rotation during hook punch resulted in greater punching power. Correlations are observed between punching powers and reach length and between acceleration and punching force. Conclusion: The key feature of this device is its low cost for Indian boxing and other developing nations’ affordability. Ultimately, this device can also be useful in athlete selection, objective performance assessment, and improvement in boxing skills. Clinical significance: This information will help medical practitioners to understand the mechanics of injury and help the athletes to prevent and manage injuries resulting from these motions.



Subham Badhyal, Abhishek K Tiwari, Sidak Dhillon, Keddin Alwar Thiagarajan, Sivaraman Arumugam

Noninvasive Method of Force Estimation of Lower Limb Muscles in Cricket Fast Bowlers: Can This be an Application to Minimize Potential Injury?

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:5] [Pages No:236 - 240]

   DOI: 10.5005/jp-journals-10028-1410  |  Open Access |  How to cite  | 


Background: Musculoskeletal modeling uses experimental data (motion capture data, both kinematics and kinetics) as an input to estimate the internal loading conditions; this noninvasive method is being validated by the research community for various activities and sports. With the heightened interest in Cricket in the Indian subcontinent, lower limb injuries are being increasingly documented in fast bowlers in cricket. The knowledge of muscular loading in lower limb during fast bowling has the potential to provide more insight into the mechanism of injury and help in prevention and management of the injury. Aims: We aimed to document the muscle and joint contact forces in lower limbs of fast bowlers to see if these could act as indirect determinants to prognosticate injury potential. Materials and methods: Experimental gait data from four Indian male state-level fast bowlers with no musculoskeletal injury in the past 6 months were collected in a gait laboratory. Both kinematic and kinetic data were collected using Plug-in Gait marker protocol. Inverse kinematics and inverse dynamics were used on the processed data to predict the internal joint loads. Static optimization was then used to estimate the muscle loading in the lower limb using OpenSim. Results and discussion: Peak front foot vertical ground reaction forces were between 5.86 and 9.10 BW (body weight). Based on the kinematic and kinetic input, the forces induced in the muscles and their loading pattern for front lower limb were determined. This loading information (muscle force pattern) could act as an input for subject-specific interventions. Conclusion: This study provides an insight to understand the lower limb muscular loading in fast bowlers. This information can be utilized by the sport scientists and medical professionals to access the injury in a more subject-specific manner. This quantitative information on lower limb loading at various joints will help in designing efficient strengthening and rehabilitation protocol for individual fast bowler.



Aman Hooda

Brief Narrative: An Orthopedic Surgeon's Experience as a Boxing Team Doctor

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:3] [Pages No:241 - 243]

   DOI: 10.5005/jp-journals-10028-1373  |  Open Access |  How to cite  | 


The experience of an orthopedic surgeon selected to be the doctor of the Indian boxing team is presented, right from the news of getting selected for the post till the arrival back to India with the championship trophy. The preparedness prior to joining was very different, due to limited exposure to sports medicine protocols, which are different from orthopedics. The team expectations were different, and the Doctors’ expectations were different, but as the days went by, bonds strengthened, and a mutual understanding developed, leading to the doctor becoming an integral part of the Indian boxing team. The coaches were receptive and open to my suggestions to improve the performance of the players. This was a learning experience for both the team players, management and coaches, and the orthopedic surgeon who accompanied them as a team doctor.



Aditya Aggarwal, Pankaj Mahindra, Rajnish Garg, Harpal S Selhi

Is there a Role of Routine Use of Topical Tranexamic Acid in Hemiarthroplasty?

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:4] [Pages No:244 - 247]

   DOI: 10.5005/jp-journals-10028-1397  |  Open Access |  How to cite  | 


Background: Blood loss is one of the major perioperative problems in elderly patients undergoing hemiarthroplasty. Such patients, if they require blood transfusion, may be exposed to the complications associated with the same. Intravenous tranexamic acid (TXA) has been used with success in preventing blood loss in total knee arthroplasty and total hip arthroplasty. Concern about thromboembolic complications has led to the topical use of TXA in both TKA and THA. We prospectively evaluated the efficacy of topical TXA for reduction of blood loss in patients undergoing hemiarthroplasty and the related need for blood transfusion. Materials and methods: Fifty-nine patients aged more than 60 years who presented with a fresh femoral neck fracture and were planned for hemiarthroplasty were randomly divided into two groups. Twenty-nine patients (study group) had local use of TXA during surgery, and 30 patients (control) had only placebo. Postoperative blood loss estimation was compared, which was estimated by hemoglobin (Hb) balance formula based on the postoperative fall of hemoglobin and hematocrit when compared to preoperative values. Complications such as postoperative bleeding, rehabilitation delays, and infection rates were documented. Results: The Hb decline on the fifth postoperative day in the study group was 1.15 ± 0.40 g/dL in contrast to 1.97 ± 0.60 g/dL in the control group (p value 0.001). The blood loss in the study group was 694.14 mL when compared to 1000.2 mL in the control group patients (p value 0.001). Conclusion: Despite inherent limitations, the study demonstrated effectiveness of topical use of TXA for decreasing blood loss and reducing need of blood transfusion in hemiarthroplasty patients.



Riddhi Gohil, Sunny Sachdeva, Saurabh Gupta

Epicollect5: A Free, Fully Customizable Mobile-based Application for Data Collection in Clinical Research

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:4] [Pages No:248 - 251]

   DOI: 10.5005/jp-journals-10028-1375  |  Open Access |  How to cite  | 


Meticulous data collection is indispensable for clinical research. Traditionally, data collection involves pen and paper materials, wherein the researcher enters data onto prespecified data collection forms. This method is cumbersome, time-consuming, and fraught with errors. With the advent of smartphone technology, it is now possible to use data collection applications for this purpose. In this review, we look at EpiCollect5, a free-to-use application that allows creation of fully customizable databases for use in clinical research.



Himanshu Bhayana, Pratik M Rathod

Book Review: Manual of Fracture Management–Foot and Ankle [AO Trauma: Rammelt S, Swords M, Dhillon MS, Sands A: Thieme Publishers (Jan 2020)]

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:1] [Pages No:252 - 252]

   DOI: 10.5005/jp-journals-10028-1419  |  Open Access |  How to cite  | 



Statistics Corner: Data Visualization–I

[Year:2020] [Month:October-December] [Volume:54] [Number:4] [Pages:4] [Pages No:253 - 256]

   DOI: 10.5005/jp-journals-10028-1412  |  Open Access |  How to cite  | 


Reality check Above all else show the data – Edward Tufte The presentation of data with the help of various charts and graphs has become an almost indispensable component of scientific research. However, unlike many other subjects, data visualization is rarely taught in undergraduate and postgraduate courses. An investigator wants to communicate complex ideas of the study findings with the help of graphs. A significant challenge before the researcher is to produce quality graphs for easy and effective communication. Therefore, the researcher intends to know the answers to a few questions before finalizing the graphical display. • What is graphical excellence? • How to achieve graphical excellence? • What is the role of the preattentive attributes in graphical excellence? • Why Gestalt principles are important for attaining graphical excellence?


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